Patients with mild traumatic brain injury and a negative CT scan of the head should be followed up at 2 weeks post-injury for better rehabilitation and functional outcomes, suggests a study reported in JAMA Network Open.¹

To analyse the recovery outcomes at 2 weeks and 6 months in patients with mild traumatic brain injury (TBI) and a negative CT scan of the head presenting to level I trauma centers in the United States, researchers examined 991 participants from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study recruited between January 2014 to December 2018. These patients had a Glasgow Coma Scale (GCS) score of 15. Their mean age was 38.5 years; men comprised 64% of the study population. Analysis of data was performed from September 2021 through to May 2022.

At 2 weeks post-injury, among 751 patients, only 27% had functional recovery to preinjury levels with a Glasgow Outcome Scale-Extended (GOS-E) score of 8, while 73% had incomplete recovery with GOS-E scores less than 8. Six-month follow-up data was available for 659 participants. Of these, less than half (44%) had functional recovery and 56% had incomplete recovery.

Those who had incomplete functional recovery at 2 weeks and 6 months reported disturbed relationships with family and friends, difficulty in carrying out social activities and inability to return to baseline. Functional recovery was likely to be incomplete among participants who had depression, anxiety, posttraumatic stress disorder and schizophrenia before the head injury.

Likewise, when Rivermead Post Concussion Symptoms Questionnaire (RPQ) scores assessing the severity of post-concussion symptoms were compared at 2 weeks and 6 months, the scores were lower among patients with complete recovery compared to those who showed incomplete recovery; 7 vs 23 at 2 weeks and 4 vs 22 at 6 months.

This study suggests that most patients who have suffered a mild traumatic brain injury, with GCS score of 15 and no positive findings on head CT scan do not completely regain their function, at 2 weeks and even up to 6 months, to levels prior to sustaining the injury. “Although all-cause mortality for mild TBI is low, studies have found that patients are at a substantial risk for serious sequelae in the first 6 months after injury”, note the authors. These findings therefore call for increased physician awareness about the possibility of incomplete recovery among such patients, who should be advised to return for follow-up examinations at 2 weekly intervals to identify those with incomplete functional recovery to enable timely institution of rehabilitation.

Reference

1. Debbie Y Madhok, et al; TRACK-TBI Investigators. Outcomes in patients with mild traumatic brain injury without acute intracranial traumatic injury. JAMA Netw Open. 2022 Aug 1;5(8):e2223245. doi: 10.1001/jamanetworkopen.2022.23245.